Behavioral health providers have their own battles with insurance companies | MCU Times

Behavioral health providers have their own battles with insurance companies

Jennifer McAtamney, CEO of Building Hope Summit County, discusses mental health care September 17, 2019. Building Hope is a non-profit organization in Summit County that works to promote better mental health.
Liz Copan / Summit Daily News Archive

Da Dr. Theresa Clark opened her practice in January 2020, she did so due to the high level of need for psychiatric services in Summit County. Now, almost two years later, she is facing an uphill battle with insurance companies, which she said makes it difficult for her to offer her services.

Clark owns and operates Ten Mile Health & Wellness in Dillon, and she is one of a handful of clinics experiencing problems with Bright Health. But while she’s optimistic, Bright Health is working to address unresolved claims, but she’s not so sure about her partnership with Anthem Blue Cross Blue Shield – one of the most popular health insurance companies in Summit County.

Clark said she officially terminated her contract with Anthem in October. This poses a risk to community members who need mental health care. Clark is one of very few providers offering psychiatric services, and if she is unable to accept one of the few carriers with plans available in the community, then it greatly limits the community’s access to mental health resources.

“I partnered with Anthem towards the beginning of 2021 and just ended my partnership with Anthem in a way related to their unwillingness to discuss meeting appropriate area rates for reimbursement,” Clark said. “From a confidentiality point of view with the insurance companies, we are not allowed to disclose the actual rates or fees, but what I can say is that Anthem is currently operating, or would like to operate, according to a fee plan they established in 2013.”

Before ending her relationship with Anthem, Clark said she had tried to work out a deal where she would be compensated for her services for what she thought was an appropriate amount, but that Anthem was not interested. Clark said the carrier told her that its network of providers was satisfactory and that its current fee schedule should be appropriate for this area.

Frustrated, Clark said she asked Anthem to provide her with a list of providers in the network that could provide her Anthem-covered patients with medical care. Patients covered by Anthem accounted for about 20% of Clark’s total patients. Using Anthem’s list, Clark would then refer his patients to other psychiatrists. When she received the list, she was startled.

On the list were four doctors. A doctor’s office is now closed, one was retired and no longer provided services, one focused on children and young people and was not based in the county, and the latter was part-time and ordered new patient evaluations until mid-January, she said.

“There is access to care, but access to care in the county? It does not seem like a sufficient network to me as someone living in Summit County, ”Clark said. “If I needed psychiatric treatment myself, I would have to wait until mid-January to wait to see a doctor, and as a consumer you would not have to wait 2 1/2 or three months to see someone in your area when there are providers in your area that would be available within a few weeks. “

The impact on society is not lost on Jennifer McAtamney, CEO of Building Hope Summit County, a local nonprofit organization for mental health. McAtamney pointed out that some of Clark’s patients now have to pay for her services themselves, and that others will seek other ways to get help, whether it means traveling further for the same services or seeking help from Building Hope’s mental health scholarship program.

McAtamney’s biggest concern, however, is how it will affect a person’s continuum of care. When most individuals seek care, they explore a wide range of options, such as medication and therapy, and it usually proves to be successful. When part of this care is interrupted, it can be harmful to the patient.

“When you are on some of these psychiatric medications for high levels of anxiety or depression, the continuity of taking that medication is extremely important to patients,” McAtamney said. “Often, not being able to see the psychiatrist you’ve seen before can really cause a delay or a delay in getting your medication filled because you have to see the psychiatrist to get that prescription filled.”

McAtamney is aware of the common pains of how insurers do not often meet the mental health needs of their consumers. She said that according to data from 2019, 56% of the people who used the Building Hope scholarship program had health insurance, but no providers in the community accepted the carrier. McAtamney said since then, Building Hope has worked, in part with the Peak Health Alliance, to get providers to accept carriers to expand access in the community.

“One of the things we looked at is the growth of our scholarship program and the increased need for behavioral health services, and how we want to connect and create access for society,” McAtamney said. “We built this insurance identification program (where) Building Hope literally pays for private providers to get identification with insurance panels and then pays the billing services so they can easily take out insurance and be compensated for the work they do.”

But it’s not always that simple. McAtamney points out that when insurance companies are slow to process claims, providers are less likely to work with them.

“We worked on all those things and now we are able to be with over 40 providers approved for different insurance companies that are common to our marketplace, so that included Bright and Anthem and (Employee Benefit Management Services). .. Cigna, all those guys, “said McAtamney.” So when the insurance companies do not deal with these claims quickly, it creates a ripple effect, as the providers do not want to take out insurance and just want to go back to private pay. “

Although she no longer accepts Anthem, Clark said she accepts Bright Health, Employee Benefit Management Services and Cigna as well as Medicaid, Medicare and Building Hope scholarships. Clark said she will continue to reach out to Anthem in hopes that the two can reach a compromise in the future.

As for Anthem, Emily Snooks, the company’s director of public relations, said not all providers will partner with the insurance company to provide services to consumers.

“We have a broad network of providers that are critical to helping us achieve our goals, but we also recognize that not all providers choose to participate in our provider network,” Snooks wrote in an email. “In addition to our provider network, we also offer on-demand, virtual care options 24 hours a day, seven days a week for our members seeking behavioral health providers and resources.”

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